The Ever-changing Healthcare Climate: Managing the impacts to CSSD · The Ever-changing Healthcare...

The Ever-changing Healthcare Climate:

Managing the impacts to CSSD

Gene Ricupito, CRCST, CHL, PMP

Managing Partner, C&R Healthcare

This document is intended for educational purposes only. May not be reproduced without permission

Discussion of:

• Key trends anticipated to drive changes to global healthcare demand

• Disruptive innovations and technology developments likely to impact CSSD

• Techniques to identify change management needs (service predictors) early in their lifecycle, determine feasibility, develop business cases, and implement responses effectively

• Pathways to engage hospital executive support for process and quality improvements

Learning Objectives


• Changes in Patient Demographics – Consumers take charge

• Changing Healthcare Economy – From volume to value

• Climate Change – Service disruptions, emergent response events

• Human Resources Scarcity – Workforce recruiting, retention and development

• Accelerating Urbanization – Concentration of population, services

• Technological Breakthroughs – MIS and NII therapeutics

• Emerging Regulatory Requirements – UDI, MU, etc.

• Data Analytics – Evidence-based practices expectations

Healthcare Trends: 2016 and beyond


Shifts in patient demographics to an older, and more diverse population will generate increased demand for accessible and affordable services.

Potential impacts to CSSD services:

• Optimizing operating efficiency within CSSD departments to handle increased workload will become a greater priority

• Dealing with ‘sicker’ patient populations (increased co-morbidities) will be more prevalent. Conditions requiring greater resource utilization for chronic disease management

• Care reimbursement (Private Insurance, Medicare/Medicaid, etc.) will increase in complexity due to fiscal constraints placed on healthcare spending. Providers (and ultimately CSSD) may face more cost constraints

Shifting Patient Demographics


Shifts in the healthcare economy will require new business and financial models, greater accountability for effectiveness, cost and outcomes.

Potential impacts to CSSD services: • Increased focus on preventive care (‘operative’ avoidance) will reduce frequency of

certain types of procedures currently performed • Greater consumer financial responsibility for healthcare will cause increased

instances of delayed intervention due to consumer’s concerns over costs, impacting case complexity

• Greater consumer knowledge and awareness of aspects of care provided (i.e. implant selection, devices used, procedure outcomes, etc.) will require greater customer management

• Continued shift in venue where types of services are provided - inpatient OR vs. outpatient OR, ambulatory center vs. physician’s clinic, etc.

• Greater physician engagement in cost containment planning (supply related, resource utilization, value analysis, etc.) will be required

The Healthcare Economy


The Healthcare Economy

Source: American Journal of Medicine This document is intended for educational purposes only. May not be reproduced without permission

Greater frequency of extreme weather events will be an increasingly important factor in supply chain planning for healthcare business continuity. Potential impacts to CSSD services: • Consideration will need to be made for business continuity (disaster)

planning for temporary supply chain disruptions in the event of local/regional extreme weather or disaster conditions.

• Consideration will need to be made for contingency planning for supply chain disruptions due to backorders for products produced in regions experiencing extreme weather or disaster conditions.

• Adjustment to JIT supply chain programs as related to above. • Leveraging rapid-deployment solutions as a contingency in the event of

extreme weather or disaster conditions will be needed. This could be used to provide services to the organization, as well as for the organization to provide services to its affiliates, or other healthcare providers in another locale.

Climate Change

This document is intended for educational purposes only. May not be reproduced with out permission

Climate Change

Flooded SPD and support areas Tennessee Flood

May 2010

Deemed ‘unsalvageable” after Hurricane Katrina

Aug 2005

Demolished after direct hit by Joplin Tornado

May 2011

Charity Hospital (LSU) New Orleans, LA

Vanderbilt Children’s Hospital Nashville, TN

St. John’s Regional MC Joplin, MO


Natural Disasters (CA Style)

Closed for 10 months after Northridge Earthquake

Jan 1994

Partially collapsed during Sylmar Earthquake

Feb 1971

Sustained $4 Million in damage Napa Earthquake Aug 2014

Olive View MC San Fernando, CA

St. John’s Hospital Santa Monica, CA

Queen of the Valley MC Napa, CA


Demand for qualified technical staff will soon outpace supply and fewer available resources will intensify competition for competent staff


• Need for hospital-based certification training programs or strategic partnerships for staff augmentation will increase

• New strategies will be needed to leverage technology in addressing workforce shortages

• Changes in work performance expectations – greater implementation of lean and other methodologies to achieve efficient operations across the patient care spectrum

• Changes in working environment and work/life balance expectations will be increasingly driven by the generational differences (‘baby-boomer’ vs. ‘millennial’) of new entrants.

Human Resource Scarcity


Healthcare support professionals are the largest segment of healthcare occupations comprising 4.75 million workers, 37% of the overall workforce

Human Resource Scarcity

Source: Georgetown University


Cultural and lifestyle changes affecting personal empowerment and individual responsibility for healthcare choices will require greater direct engagement with consumers.


• Shifting population density will affect provider program focus, specialization and market competition

• Increasing pockets of culture-specific populations effect what care is needed, how care is delivered

• Development of care networks focused upon consumer expectations will affect where, when, and how interventional procedures are performed

• Lifestyle changes with downstream health consequences (Diabetes, Hypertension, Morbid Obesity, Kidney disease, etc.) will affect case mix

Accelerating Urbanization


Accelerating Urbanization

Percentage of population living in urban areas

54% of the world’s population live in metropolitan areas


Continuous and accelerating technological innovation will reshape the sterile processing landscape


• Advancements in reprocessing technologies will drive quality and productivity as related to complexity

• Technology will continue to drive the transition from open - to minimally invasive - to noninvasive perioperative intervention techniques. CSSD will need to respond accordingly

• Sterile processing environment redesign: – Continued trend toward ‘universality’ with standardization to allow for flexibility

and open-ended future expansion with technologies, and instrumentation

– Promotion of inter-departmental technology integration

– Reduction of waste, refocus toward ‘green’ programs

Technological Breakthroughs

Technological Breakthroughs

Advancements in interventional technologies …

Drive counter-measures in reprocessing technologies


Regulatory changes will drive compliance with standards and guidelines for new product development, transparency, meaningful use, and competency


• Rise in expectations of transparency in clinical supply chain (UDI)

• Growth of mandatory certification expectations for SPD professionals

• Shift in procedure types that can be performed in locations outside of hospital facility – Deep need for process management beyond traditional delivery models

• Federal stakeholders to promote legislation supporting development of telehealth technologies, extending the traditional technical ‘reach’ of the organization – will likely require processing of devices with more complex electronic components

Emerging Regulatory Requirements


Emerging Regulatory Requirements

UDI - AIDC Certification

Telehealth Interoperability


Stakeholders only benefit from big data if they take a holistic, patient-centered approach to value, one that focuses equally on healthcare spending and treatment outcomes


• Thorough planning must be undertaken to ensure that appropriate sterile processing data is captured with the appropriate structuring (standardization) to be usable for big data analytics (i.e. apples-to-apples benchmarking)

• Organizations will have increasing ability to rely on data analytics for accurate forecasting of trends within populations to predict specific community needs, affecting inventory requirements and PAR levels

Data Analytics


Data Analytics


• Movement toward a retail-inspired model "The reality is that healthcare providers are moving to a consumer-oriented approach for care,"

• Focus on population health management

“Today's healthcare CEO is incentivized to fill beds. Tomorrow's CEO will be incentivized to empty beds. You’ll have to keep your community healthy and out of the hospital.”

• Acquisitions of ancillary service lines

“Hospitals will be more incentivized to look at strategic acquisitions making sure they can control their destiny by ensuring the patient gets proper care even after discharge.” (Source: Becker’s Hospital Review & U.S. News & World Report)

3 Predictions for the Future of U.S. Healthcare


The CSSD Value Proposition

CSSD departments are the hospital’s circulatory system, assuring that the right item flows to the right place at the right time, in the right condition for use. The behind-the-scenes tasks performed here directly impact assurance of patient safety, physician satisfaction and the overall quality of services provided

Decontam

Assembly

Sterilization Storage

Distribution

The virtuous circle of CSSD

“No one knows where the CSSD is, until something goes wrong …”


The 21st Century CSSD Business Model

As the healthcare ecosystem transitions toward a value-based business model, CSSD departments will need to adapt to changing conditions and performance expectations. To be successful, CSSD leaders and staff will need to continue to adopt viewpoints, processes and techniques designed to ensure quality and sustainability.

Key factors: • Expanding customer base – Great likelihood of reprocessing for numerous

distributed points-of-care • Increasing complexity – Devices and associated reprocessing technologies

will continue to grow in their complexity • Enhanced Logistics performance – Expectation of detailed, evidence-based

chain of custody management throughout the sterilization or disinfection process and from patient-to-patient

• Enhanced Risk management performance – Risk avoidance, risk reduction, and risk response strategies will need routine evaluation for continual incremental improvements


Risks in CSSD

While there are many potential areas of risk to quality and performance in CSSD, below are two areas where technology innovations elevate risk

Among ECRI’s Top Ten Risks impacting CSSD: • Inadequate Reprocessing of Endoscopes and Surgical Instruments –

significant emphasis on decontamination practices • Data Integrity: Incorrect or Missing Data in EHRs and Other Health IT

Systems – focus on implementation strategies, data integrity and end-user competency. Risk assessments of CSSD information systems connectivity with patient care record as a pathway for legal discoverability

Primary TJC Focus Areas for CSSD: • Standard IC.02.02.01: Reducing the risk of infections associated with

medical equipment, devices, and supplies • EP2: Performing intermediate, high-level disinfection and sterilization of

medical equipment, devices, and supplies


“But we’ve always done it this way!”

Indicators that a process or program needs to be revised based on internal drivers:

Reactive indicators:

• Diminishing Quality – Increase in incident reports

– Reduction in customer satisfaction scores

• Diminishing productivity – Production capacity bottlenecks

– Unforeseen resource limitations

Identifying Change Management Needs


“But we’ve never done it this way!!!”

Indicators that a process or program needs to be revised based on external drivers:

Proactive indicators:

• Awareness of service level transition – Ex. A change in procedural venue from inpatient to outpatient

• Awareness of program change – Ex. Onboarding of new physicians/services/programs

• New regulatory standards – Ex. UDI

Identifying Change Management Needs


“Can we do this???”

Feasibility studies are a 5 step process:

1) Investigate the Business Drivers –Organizational challenges, industry trends, and regulatory expectations

2) Confirm the Alternative Solutions – Look at the entire range of options

3) Determine the Feasibility – Rank the options and their potential (pros & cons)

4) Choose the Preferred Solution – Consensus of key sponsors and stakeholders of the best decision for the organization (This is a critical success factor)

5) Reassess at a lower level – Poll end-users to gauge their perspective (focus groups)

Determining Feasibility


“Why should we do this?” Business cases capture the rationale and justification for undertaking a project and can range from comprehensive and highly structured, to informal and brief.

Information in a business case typically includes: • Background of the project or initiative • Expected business benefits • Options considered - with reasons for rejecting or carrying forward each option • Expected costs - total cost of ownership (TCO) • Gap analysis - comparison of actual performance with potential or desired

performance • Expected risks - including the costs & risks of taking no action and/or risks of

inactivity

Developing a Business Case


• Create and Communicate a Clear Business Case – Sponsors and stakeholders need to be able to see the value

• Focus on the Most Important Goals – initiatives must be aligned with other organizational goals and targeted in scope

• Seek Commitment and Accountability – Demonstrate the willingness to drive performance via accountability and follow-through

Techniques for Generating Support


Questions and Answers

C&R Healthcare Partners contact information:

Gene Ricupito

Email: [email protected]

Mobile: 310-592-7102

Rick Cunningham

Email: [email protected]

Mobile: 804-837-9704

mailto:[email protected]

mailto:[email protected]

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